Nutritional Influences on Illness: Premenstrual Syndrome; Magnesium

Nutritional Influences on Illness: Premenstrual Syndrome; Magnesium

Guy Abraham has suggested that premenstrual syndrome (PMS) can be better understood and treated if it is divided into four subgroups.( 1) Each subgroup, he believes, has its particular causes, and therefore may respond to different treatment interventions:

PMT-A (`Anxiety'): anxiety, irritability, insomnia.
PMT-C (`Craving'): sugar craving, increased appetite, `hypoglycemic' symptoms following sugar ingestion.
PMT-D (`Depression'): depression, forgetfulness, confusion.
PMT-H (`Hyperhydration'): excess fluid retention.
While several nutrients appear to be implicated in the development of PMS, magnesium is particularly interesting, as a marginal deficiency of this macromineral could explain all four subgroups. PMT-A is believed to be associated with relative dopamine depletion caused by excess estrogen.( 2) A magnesium deficiency could foster PMT-A by depleting brain dopamine.( 3) Alternatively, it could promote estrogen excess by impairing estrogen metabolism.( 4)

A magnesium deficiency could increase glucose-induced insulin secretion( 5) and thus favor the development of PMT-C. PMT-D, like PMT-A, could be fostered by a relative dopamine depletion.( 6) Finally, a magnesium deficiency could cause hyperplasia of the adrenal cortex leading to an increase in aldosterone levels. Elevated aldosterone, in turn, would increase urinary magnesium excretion.( 7) The consequence of increased aldosterone would be an increase in extracellular fluid volume and, possibly, the development of PMT-H.

If a marginal magnesium deficiency is involved in premenstrual syndrome, we would expect to find evidence of it from laboratory testing. Magnesium levels in white blood cells do appear to be low( 8) and to increase following treatment. Red blood cell magnesium levels may also be reduced.( 9) In fact, in one study the authors found that, after testing people with many different disorders, premenstrual syndrome was the only one in which they found the study group as a whole to have reduced red blood cell magnesium levels.( 10) By contrast, plasma and serum magnesium levels, which are insensitive measures of magnesium nutriture, are usually normal.( 11)

The critical clinical question, of course, is whether magnesium supplementation is effective. Indeed, studies have found it to be beneficial. An uncontrolled study of 192 women found that magnesium supplementation seemed to relieve breast pain in 96%, weight gain in 95%, nervous tension in 89%, and headache in 43%.( 12) Under double-blind conditions, magnesium supplementation was found to significantly reduce a subjective measure of total menstrual distress, as well as subjective measures related to pain and emotional distress.( 8) The ideal supplemental dosage has not been determined; however, 400 mg daily would seem reasonable.

By the way, if you do decide to supplement your patients with magnesium, consider adding perhaps 50 mg of vitamin B6. Although B6 does not appear to be deficient in this disorder,( 11) it increases cell membrane transfer and utilization of magnesium.( 13)

(1.) Abraham GE. Management of the premenstrual tension syndromes: Rationale for a nutritional approach, in J Bland, Ed. 1986: A Year in Nutritional medicine. New Canaan, CT, Keats Publishing, 1986.

(2.) Redmond DE et al. Menstrual cycle and ovarian hormone effects on plasma and platelet monamine oxidase (MAO) and plasma dopamin-hydroylase activities in the Rhesus monkey. Psychosom Med 37:417, 1975.

(3.) Barbeau A et al. Defieicne en magnesium et dopamine cerebral, in J Durlach, Ed. First International Symposium on magnesium Deficit in Human Pathology. Paris. F. Vittle, 1973:149-52.

(4.) Brown RC, Bidlack Wr. Regulation of glucuronyl transferase by intracellular magnesium, in Proceedings of the International Symposium on Magnesium and its Relationship to Cardiovascular, Renal and Metabolic Disorders. Los Angeles, 1985:24.

(5.) Curry DL et al., Magnesium modulation of glucose-induced insulin secretion by the perfused rat pancreas. Endocrinology 101:302, 1977.

(6.) Brown AS, Gershon S. Dopamine and depression. J Neurol Trans Gen Sect 91(2-3):75-109, 1993.

(7.) Horton R, Biglieri EG. Effect of aldosterone on the metabolism of magnesium. J Clin Endocrinol 22:1187, 1962.

(8.) Facchinetti F, Bolrella P, Sances G, et al., Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol 78(2):17-81, 1991.

(9.) Abraham GE, Lubran MM. Serum and red cell magnesium levels in patients with premenstrual tension. Am J Clin Nutr 34(11):2364-6, 1981.

(10.) Sherwood RA et al. Magnesium and the premenstrual syndrome. Ann Clin Biochem 23(6):667-70, 1986.

(11.) Mira M, Stewart PM, Abraham SF. Vitamin and trace element status in premenstrual syndrome. Am J Clin Nutr 47:636-41, 1988.

(12.) Nicholas A. Traitement du syndrome pre-menstruel et de la dysmenorrhee par l'ion magnesium, in J Durlach, Ed. First International Sympsoium on Magnesium Deficit in Human Pathology. Paris, Springer, Verlag. 1973:261-3.

(13.) Atkawa JK, Proc Soc Exp Biol Med 104;461-3, 1960.

Reprinted with permission from the International Journal of Alternative and Complementary Medicine, Green Library, Homewood NHS Trust (DHQ), Guidford Road, Chertsey, Surrey KT16 0Q1, United Kingdom.

Townsend Letter for Doctors & Patients.


By Melvyn R. Werbach

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